GUT microbiome signatures may help predict cardiac remodelling in preclinical heart failure, according to a prospective cohort study that identified microbial features associated with both adverse and favourable changes in cardiac structure. The findings suggest that gut microbiome profiling could contribute to earlier risk stratification and inform future approaches to personalised heart failure management.
The study investigated whether the gut microbiome could distinguish between different trajectories of cardiac remodelling in individuals with preclinical heart failure, specifically those classified as Stage A or Stage B. A total of 124 participants were enrolled at baseline, including 85 in Stage A and 39 in Stage B.
Following 1 year of follow up, participants were classified according to whether they experienced adverse or reverse remodelling. Researchers analysed stool samples using full length 16S ribosomal RNA sequencing and applied machine learning alongside differential abundance analysis. An independent cohort of 94 participants was also included to evaluate model robustness.
The analysis identified 20 leading microbiome features that predicted adverse remodelling with an accuracy of 76% and an area under the curve (AUC) of 0.86. For reverse remodelling, the model achieved an accuracy of 85% and an AUC of 0.95.
Findings supported by both machine learning and DESeq2 included four bacterial genera: Romboutsia, Alloprevotella, Klebsiella, and Enterobacter. Five species were also identified: Romboutsia ilealis, Alloprevotella rava, Klebsiella variicola, Klebsiella pneumoniae, and Enterobacter roggenkampii.
Pathway analysis suggested that R. ilealis might have beneficial associations in Stage AA through short chain fatty acid and ketone body metabolism. Conversely, Klebsiella species and E. roggenkampii were potentially linked to pro inflammatory processes in Stage BB.
Validation analyses demonstrated stable model performance, with AUC values ranging from 0.75 to 0.80 in the independent cohort. These results supported the potential reproducibility of microbiome-based predictions across separate participant groups.
The findings position the gut microbiome as a potential source of biomarkers for identifying individuals at risk of adverse cardiac remodelling before symptomatic heart failure develops. They also raise the possibility that microbial pathways could represent future therapeutic targets.
However, the results establish predictive potential and microbial associations rather than causation or proven clinical benefit. Further research will be needed to determine whether these signatures can be translated into routine clinical practice and whether microbiome directed interventions can influence cardiac remodelling outcomes.
Reference
Yang NI et al. Discovering gut microbiome signatures that predict adverse and reverse cardiac remodeling in preclinical heart failure. Commun Med. 2026;DOI:10.1038/s43856-026-01949-0.
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